Multi – Long Form

Last Updated on March 24, 2023 by Neil Murray

Form – contact-form-7 id=”3514″ title=”Test – Multi – Long Form (test if scrolls to top)”

    Personal Information

    Date of Birth*:

    Gender*:

    FemaleMaleSelf-Describe

    If you selected 'Self-Describe' above, please describe:

    Race:

    American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhite/European

    Ethnicity:

    Hispanic or LatinoNot Hispanic or Latino

    Employment History

    Please provide employment information for the past five years, with most recent position held first. If more space is needed use an extra sheet of paper.

    Dates of Employment:

    From*:

    To*:

    Dates of Employment:

    From*:

    To*:

    Dates of Employment:

    From*:

    To*:

    INFORMATION RELEASE

    In completing this application to be a volunteer, I understand that I am not an agent or employee of Youth Services, and I further understand that this form is not an application for employment. I understand that Youth Services routinely conducts Washington State Division of Children and Family Services screen and national criminal checks, driving record checks, and domestic violence and dependency actions reviews. If I have not resided in Washington State for at least 3 years, a record check in my previous state(s) of residency will be conducted. Yes

    I certify to the best of my ability that the information provided on this application is true and accurate and that I am agreeing to a minimum commitment of one hour per week for one year. I also understand that misinformation knowingly provided herein and on subsequent volunteer information forms, or information deliberately withheld, is grounds for dismissal. Yes

    By checking this box, I also give my permission to contact references listed below or to pursue information from any sources listed. Yes

    MEDIA RELEASE FORM

    I give my consent to the use of my name, references to my place of employment, photographs, videotapes, DVD, film, social media and recordings of me for use by Youth Services in connection with promoting, marketing, and recruiting for the Youth Services program.

    In giving this consent, I release Youth Services, its officers, directors, agents, employees, and assigns from any liability for any violation of any personal property rights which I might have in connection with such materials and waive any right to approve accompanying written or narrative material.

    Confirmed and agreed to: Yes

    COMMUNITY-BASED PROGRAM TRANSPORTATION FORM

    Vehicle Insurance Company Information

    In completing this application to be a volunteer, I understand that Youth Services provides no auto insurance coverage for volunteers, and does not agree to indemnify the said volunteer for any legal liability arising out of transporting any person while on a volunteer assignment. I will apprise Youth Services as changes occur in my insurer's name or insurance coverage. Yes

    [recaptcha]